机器人辅助与腹腔镜下复杂性肾肿瘤（RENAL评分≥7）部分肾切除术的围手术期、功能及肿瘤学结局：一项循证分析

Perioperative, functional, and oncological outcomes of robotic vs. laparoscopic partial nephrectomy for complex renal tumors (RENAL score ≥7): an evidence-based analysis.

作者信息

Wang Li, Deng Jing-Ya, Liang Cai, Zhu Ping-Yu

机构信息

Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.

Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.

出版信息

Front Oncol. 2023 Jun 2;13:1195910. doi: 10.3389/fonc.2023.1195910. eCollection 2023.

OBJECTIVE

To evaluate the current literature comparing outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) treating complex renal tumors (RENAL nephrometry score ≥7).

METHODS

We systematically searched the Cochrane Library, PubMed, Google Scholar, EMBASE, and Scopus databases up to March 2023. Review Manager 5.4 performed a pooled analysis of the data for random effects. Besides, sensitivity and subgroup analyses to explore heterogeneity, Newcastle-Ottawa scale, and GRADE to evaluate study quality and level of evidence.

RESULTS

Eight observational studies comprising 1346 patients (RPN: 695; LPN: 651) were included in this study. Compared to LPN, RPN had a shorter operative time (OT) (weight mean difference [WMD]: -14.73 min; p = 0.0003), shorter warm ischemia time (WIT) (WMD: -3.47 min; p = 0.002), lower transfusion rate (odds ratio [OR]: 0.66; p = 0.04), shorter length of stay (LOS) (WMD: -0.65 days; p < 0.00001), lower postoperative estimated glomerular filtration rate (eGFR) change (WMD = -2.33 mL/min/1.73 m2; p = 0.002) and lower intraoperative complications (OR: 0.52; p = 0.04). No significant differences were observed between the two groups in terms of estimated blood loss (EBL) (p = 0.84), conversion to radical nephrectomy (p = 0.12), postoperative complications (p = 0.11), major complications (defined Clavien-Dindo grade 3 (p = 0.43), overall complications (p = 0.15), postoperative eGFR (p = 0.28), local recurrence (p = 0.35), positive surgical margin (PSM) (p = 0.63), overall survival (OS) (p = 0.47), cancer-specific survival (CSS) (p = 0.22) and 3-year recurrence-free survival (RFS) (p = 0.53).

CONCLUSION

Patients with complex renal tumors (RENAL score ≥7), RPN is superior to LPN in decreasing the OT, WIT, LOS, transfusion rate, change in eGFR and the incidence of intraoperative complications while maintaining oncological control and avoiding a decline in renal function. However, our findings need further validation in a large-sample prospective randomized study.

目的

评估当前比较机器人辅助肾部分切除术（RPN）与腹腔镜肾部分切除术（LPN）治疗复杂肾肿瘤（RENAL肾计量评分≥7）疗效的文献。

方法

我们系统检索了截至2023年3月的Cochrane图书馆、PubMed、谷歌学术、EMBASE和Scopus数据库。Review Manager 5.4对数据进行随机效应的汇总分析。此外，进行敏感性和亚组分析以探索异质性，采用纽卡斯尔-渥太华量表和GRADE评估研究质量和证据水平。

结果

本研究纳入了8项观察性研究，共1346例患者（RPN组：695例；LPN组：651例）。与LPN相比，RPN的手术时间（OT）更短（加权均数差[WMD]：-14.73分钟；p = 0.0003），热缺血时间（WIT）更短（WMD：-3.47分钟；p = 0.002），输血率更低（比值比[OR]：0.66；p = 0.04），住院时间（LOS）更短（WMD：-0.65天；p < 0.00001），术后估计肾小球滤过率（eGFR）变化更低（WMD = -2.33 mL/min/1.73 m²；p = 0.002），术中并发症发生率更低（OR：0.52；p = 0.04）。两组在估计失血量（EBL）（p = 0.84）、转为根治性肾切除术的比例（p = 0.12）、术后并发症（p = 0.11）、主要并发症（定义为Clavien-Dindo 3级，p = 0.43）、总体并发症（p = 0.15）、术后eGFR（p = 0.28）、局部复发（p = 0.35）、手术切缘阳性（PSM）（p = 0.63）、总生存期（OS）（p = 0.47）、癌症特异性生存期（CSS）（p = 0.22）和3年无复发生存期（RFS）（p = 0.53）方面未观察到显著差异。